This is Steven Salzberg's blog on genomics, pseudoscience, medical breakthroughs, higher education, and other topics, including skepticism about unscientific medical practices. Here's where I can say what I really think about abuses and distortions of science, wherever I see them.

NCCAM, weight loss scams, and acupressure

Looking for questionable projects funded by NIH’s NCCAM (the National Center for Complementary and Alternative Medicine) is like shooting fish in a barrel. It’s also painful, because I know these funds could have been invested in real science and medicine instead of quackery. Nonetheless, we shouldn’t give NCCAM a free pass to waste our money. Perhaps after enough critical scrutiny, Congress (which created NCCAM in the first place) will realize that precious federal research dollars need to go into real research, not scams.

My latest search hit on a study called “Randomized Trial of Tapas Acupressure for Weight Loss Maintenance”, an R01 grant (R01-AT003928) from NCCAM to Charles Elder at the Oregon Center for CAM (OCCAM) run by Kaiser Permanente Northwest. This is one of NCCAM’s big national centers of research, and I quickly learned that the acupressure grant was just the tip of the iceberg.

Let’s start with Elder’s study. The Kaiser site says that Elder trained with them in “meditation and Ayurvedic medicine”. That’s reassuring. (See my earlier blog entry on Ayurveda.) This new project was funded based on a pilot study in which Elder “assess[ed] the feasibility and impact of two mind-body interventions from the Chinese Medicine tradition for weight loss maintenance in overweight and obese adults.” He explains that the method he wants to pursue further, the Tapas Acupressure Technique (TAT):

warrants further research as a potential tool for weight loss maintenance. The TAT procedure combines self-acupressure administration with specific mental focus. Patients are taught how to first identify counterproductive beliefs and actions, focus on those images while applying pressure to acupoints GB21, BL1, and Yin Tang, and then transition to a focus on positive images.

In other words, they press their hands on certain points on their own bodies (“self-acupressure) while thinking certain thoughts, and this will help them with “weight loss maintenance.” Notice that he’s not claiming it will help them lose weight in the first place, just that it will help keep the weight off. Hmm.

Okay, there’s too much meaningless mumbo jumbo in those few sentences for me to refute it, but let’s ask a simpler question: what did that pilot study really show? It must have been pretty exciting to justify an R01 grant – these are NIH’s most prestigious and most competitive awards, and NIH rejects almost 90% of R01 applications right now because funding is so tight.

Elder published his results, in a 2007 paper called “Randomized trial of two mind-body interventions for weight-loss maintenance,” in the Journal of Alternative and Complementary Medicine. First I have to point out that this is a terrible journal, created by CAM practitioners as a vehicle for publishing their results. Their editorial board (no suprise) consists mostly of CAM practitioners from highly questionable institutions, such as The Academy for Future Science (no, I’m not making that up) and the Oregon College of Oriental Medicine.

But hey, maybe this article is better than most in that journal. So what did they do? They recruited a small number (92) of overweight adults, and put them all through a 12-week weight-loss program. Then they used three methods to help them keep the weight off: qigong, or “qi”; Tapas Acupressure, or TAT, and a “self-directed support” group as a control. The results of this small, poorly-controlled study: the TAT group regained 0.1 kg, the controls regained 1.3 kg, and the qi group regained 2.9 kg. They claim that this very slight advantage for the TAT group over the controls means that “TAT warrants further research.” How about qi? Do they admit it doesn’t work? No, they say “further research on qigong should use a modification of our protocol.”

My conclusion is different: none of this stuff works, so they resort to to publishing a crappy study in an even crappier journal. A small random variation is reported as a significant win for acupressure (they claim a p-value of 0.13 in their original abstract, later revised to 0.09, which most scientists would never report as significant, and why should I believe these guys’ statistics anyway?), and they then go to NIH and ask for funding to continue the work. All this would be easy to ignore if the lead author weren’t getting a prestigious NIH R01 grant to continue the work. It’s so outrageous that it is hard to know which is worse: the sad waste of NIH funds, the shameless misleading of the public, or the act of taking patients’ money and giving them therapies that don’t work.

By the way, what the heck is acupressure? Well, it’s just what you might guess: acupuncture without needles. You just use your hands to put pressure on various points on the body. Reviews of clinical trials conducted by the Cochrane reviews, one of the best review groups in the biomedical literature, have shown that acupressure doesn’t work – for anything. For weight loss? Not a chance.

But wait, there's more! The Oregon CAM Center also funds “researchers” (I have to put that in quotes) at the National College of Natural Medicine in Portland, Oregon. I guess I shouldn’t be surprised to read that these places exist, but their own description of what they do, and what they train their students to do, is so filled with nonsense that it is scary. Here’s a quote from their site:

NCNM offers two graduate professional degrees... Doctor of Naturopathic Medicine, a four-year program of clinical sciences and holistic methods of healing and disease prevention, instilled with the ancient principle of the healing power of nature. Master of Science in Oriental Medicine (MSOM), a four-year program that delves deeply into thousands of years of classical Chinese methods of diagnostics and healing, using herbs, acupuncture, bodywork and therapeutic exercise.

But don’t worry, their degrees are accredited by the Council on Naturopathic Medical Education and the Accreditation Commission for Acupuncture and Oriental Medicine. I’ll have to devote more space to naturopathy later: this is one of the worst of the scam practices supported by NCCAM. It’s appalling to see NIH supporting it – and equally appalling that at least three naturopaths (they call themselves “naturopathic doctors” although they do not have a medical degree) have served on the NCCAM Advisory Council. In fact, one of them – a “professor” at NCNM – is on the NCCAM Council now.

I wish this were harmless mumbo-jumbo, but it isn’t. People spend money to get treated by these methods that have no basis in physiology, anatomy, medicine, or any other branch of science, and that don’t work, and sometimes they miss out on real treatments that do work. It is sad that such pathetically poor proposals are getting NIH funding when so many worthwhile, legitimate NIH proposals are being turned down because of lack of funds. (NCCAM runs its own review panels because the projects they fund would have no chance if they had to compete against real science.) I can’t help thinking that if the public knew that good proposals to treat cancer, heart disease, infectious diseases, and countless other real problems were being turned down in favor of acupressure and naturopathy, they would join me in calling on Congress to shut down NCCAM and return its funds to other NIH institutes.

3 comments:

Don't know about the acupressure part, but I can tell you from experience that any application of tapas that involves eating them isn't going to be good for weight loss maintenance. Sure, they look small, but that only means you are going to order more.

I've seen the Lyme disease claim made for acupuncture too. It is laughably ridiculous to anyone who knows that Lyme disease is a bacterial infection (caused by Borrelia burgdorferi, which we sequenced in 1997 at TIGR - one of the first genome projects I was involved in).

I've also read accounts where acupuncturists claim to cure colds and other infections. Some of them actually seem to believe this. I can only shake my head in amazement (LOL).